A qualitative study of resident and early-career family physicians’ focused practice choices in Canada

Background: Although focused practice within family medicine may be increasing globally, there is limited research on the factors contributing to decisions to focus practice. Aim: We aimed to examine the factors influencing resident and early-career family physician choices of focused practice across three Canadian provinces. Design and Setting: We analyzed a subset of qualitative interview data from a study across British Columbia, Ontario, and Nova Scotia. Method: A total of 22 resident family physicians and 38 early-career family physicians in their first 10 years of practice who intend to or currently practice in a focused area were included in our analysis. We compared participant types, provinces, and the degree of focused practice while identifying themes related to factors influencing the pursuit of focused practice. Results: We identified three key themes of factors contributing to choices of focused practice: self-preservation within the current health care system, support from colleagues, and experiences in medical school and/or residency. Minor themes included alignment of practice with skills, personal values, or ability to derive professional satisfaction; personal lived experiences; and having many attractive opportunities for focused practice. Conclusion: Both groups of participants unanimously viewed focused practice as a way to circumvent the burnout or exhaustion they associated with comprehensive practice in the current structure of the health care system. This finding, in addition to other influential factors, was consistent across the three provinces. More research is needed to understand the implications of resident and early-career family physician choices of focused practice within the physician workforce.

“This is not my body”: Therapeutic experiences and post-treatment health of people with rifampicin-resistant tuberculosis

Background There are few data on the on post-treatment experiences of people who have been successfully treated for rifampicin-resistant (RR-)TB. Objective To describe the experiences and impact of RR-TB disease and therapy on post-treatment life of individuals who were successfully treated. Methods In this qualitative study in-depth interviews were conducted among a purposively selected sample from a population of individuals who were successfully treated for RR-TB between January 2008 and December 2018. Interview transcripts and notes were analysed using a thematic network analysis which included grounded theory and a framework for understanding pathophysiological mechanisms for post-TB morbidity and mortality. The analysis was iterative and the coding system developed focused on disease, treatment and post-treatment experiences of individuals. This paper follows the COREQ guidelines. Results For all 12 participants interviewed, the development of RR-TB disease, its diagnosis and the subsequent treatment were a major disruption to their lives as well as a transformative experience. On diagnosis of RR-TB disease, participants entered a liminal period in which their lives were marked with uncertainty and dominated by physical and mental suffering. Irrespective of how long ago they had completed their treatment, they all remembered with clarity the signs and symptoms of the disease and the arduous treatment journey. Post-treatment participants reported physical, social, psychological and economic changes as consequences of their RR-TB disease and treatment. Many participants reported a diminished ability to perform physical activities and, once discharged from the RR-TB hospital, inadequate physical rehabilitation. For some, these physical limitations impacted on their social life, and ultimately on their psychological health as well as on their ability to earn money and support their families. Conclusion The experiences and impact of RR-TB disease and therapy on post-treatment life of individuals successfully treated, highlights gaps in the current health care system that need to be addressed to improve the life of individuals post-treatment. A more holistic and long-term view of post-TB health, including the provision of comprehensive medical and social services for post-treatment care of physical ailments, social re-integration and the mitigation of the perceived fear and risk of getting TB again could be a central part of person-centred TB care.

The current problems regarding health services faced by health care servants in rural Maharashtra: An onfield report

The current report deliberates the challenges encountered by the various sectors of healthcare workers while executing their services. The study is confined to Indian state of rural Maharashtra precisely involving the small town Masur and Karad city of Satara district. Here, we tried to better comprehend the daily problems confronted by the health workers while rendering their services especially in rural area. For the purpose we met with the various health workers including physician, nurse, blood bank founder, and the pharmacist. All of them highlighted the problems they dealt with while rendering their daily services and also emphasized on implications of covid 19 on their duties. Niti Ayog has already warned center regarding the possibility of third wave of covid 19 by the end of September 2021 with 4-5 lakhs daily cases. Indeed, this is alarming and may curtail current health care system. Taking into account the daily challenges confronted by the healthcare personals and possible damage by covid 19, the current heathcare system especially in rural Maharashtra need a substantial boost.

Gender Aspects of Reproduction of Professional Dynasties in Medicine

The number of female health workers is predominant in the current health care system. However, in terms of the distribution of power and authority, career trajectories, and the culture of relationships, medicine still remains gender-related to men. Reproduction processes of the professional structure of medicine, in which professional dynasties occupy a special place, is also marked by gender differences. Thus, the article addresses the gender specificities of the institutional reproduction of medical dynasties in modern Russia. Based on in-depth interviews with twenty representatives of multigenerational families of doctors from ten cities, gender scenarios for the transmission of professional positions and the gender specificity of using the social and symbolic capital of the dynasty in the context of their reproduction are analyzed. According to the empirical research findings, the dynastic model of marital status transfer maintains and reproduces gender inequality in the medical profession. There is low gender sensitivity in doctors’ dynasties, where women are more likely to be passive or under family pressure to pursue educational and work tracks. The choice of professional specialization is conditioned by gender stereotypes. Career and professional opportunities of women doctors are limited by an imbalance between work and home responsibilities. Dynasty social and symbolic capital investment strategies are less resourceful for women in clinical practice and more effective in academic medicine. The deconstruction of the traditional gender display in the profession is proceeding at a slow pace, while medical dynasties continue to rather reproduce the inequality and male ethics of the medical profession.

AB569, A Novel, Topical Bactericidal Gel Formulation, Kills Pseudomonas aeruginosa and Promotes Wound Healing in a Murine Model of Burn Wound Infection

Cutaneous thermal injuries from burns/explosives are a major cause of morbidity and mortality and represent a monumental burden on our current health care system. Injury severity is predominantly due to potentially lethal sepsis caused by multi-drug resistant (MDR) bacteria such as Pseudomonas aeruginosa (MDR-PA). Thus, there is a critical need to develop novel and effective antimicrobials for the (i) prevention, (ii) treatment and (iii) healing of such wounds that are complicated by MDR- PA and other bacterial infections. AB569 is a novel bactericidal tandem consisting of acidified NaNO 2 (A-NO 2 - ) and Na 2 -EDTA. Herein, we first show that AB569 acts synergistically to kill all human burn wound strains of PA in vitro. This was found to be due, in part, to the generation of A-NO 2 - mediated nitric oxide (NO) formation coupled with the metal chelating properties of Na 2 -EDTA. Using a murine scald burn wound model of PA infection, an AB569-Solosite® gel formulation eradicated all bacteria. Futher, we also demonstrate enhanced AB569-mediated wound healing by not only accelerating wound contraction, but also by reducing levels of the pro-inflammatory cytokines IL-6 IL-1β.while increasing the levels of anti-inflammatory cytokine, IL-10 and granulocyte-colony stimulating factor (G-CSF). We also observed better epidermal restoration in AB569 treated wounds. Taken together, we conclude that this study provides solid foundational evidence that AB569 can be used topically to treat highly problematic dermal insults including wound, burn, blast and likely diabetic infections in civilian and military populations, and help relieve the economical burden that MDR organisms have on the global health-care system.

Early Palliative Care for Oncology Patients: How APRNs Can Take the Lead

Background: Patients with cancer need expert and multidisciplinary care throughout the trajectory of their illness. Palliative care should be instituted early in the course of their disease. Early palliative care enables patients and their families to control physical, psychological, social, and spiritual symptoms of the disease. In our current health-care system, early palliative care is not being integrated due to a lack of education of providers and nurses, an infrastructure that does not support palliative medicine, and poor communication skills among practitioners. Methods and Results: The Palliative Care Quiz for Nursing (PCQN) completed by nurse practitioners at a large Midwest cancer center found that those nurse practitioners had a poor understanding of the basic precepts of palliative care. This is consistent with the current literature. Conclusion: Advanced practice nurses should be educated on the principles of palliative care, as they are perfectly situated to advance the integration of early palliative care in the oncology setting.

Factors influencing focused practice: A qualitative study resident and early-career family physician practice choices

Background: Although focused practice within family medicine may be increasing globally, there is limited research on the factors contributing to decisions to focus practice. We aimed to examine the factors influencing resident and early-career family physician choices of focused practice across three Canadian provinces. Methods: We analyzed a subset of qualitative interview data from a study across British Columbia, Ontario, and Nova Scotia. A total of 22 resident family physicians and 38 early-career family physicians in their first 10 years of practice who intend to or currently practice in a focused area were included in our analysis. We compared participant types, provinces, and the degree of focused practice while identifying themes related to factors influencing the pursuit of focused practice. Results: We identified three key themes of factors contributing to choices of focused practice: self-preservation within the current health care system, support from colleagues, and experiences in medical school and/or residency. Minor themes included alignment of practice with skills, personal values, or ability to derive professional satisfaction; personal lived experiences; and having many attractive opportunities for focused practice. Interpretation: Both groups of participants unanimously viewed focused practice as a way to circumvent the burnout or exhaustion they associated with comprehensive practice in the current structure of the health care. This finding, in addition to other influential factors, was consistent across the three provinces. More research is needed to understand the implications of resident and early-career family physician choices of focused practice within the physician workforce.

Wearable Hardware Design for the Internet of Medical Things (IoMT)

As the life expectancy of individuals increases with recent advancements in medicine and quality of living, it is important to monitor the health of patients and healthy individuals on a daily basis. This is not possible with the current health care system in North America, and thus there is a need for wireless devices that can be used from home. These devices are called biomedical wearables, and they have become popular in the last decade. There are several reasons for that, but the main ones are: expensive health care, longer wait times, and an increase in public awareness about improving quality of life. With this, it is vital for anyone working on wearables to have an overall understanding of how they function, how they were designed, their significance, and what factors were considered when the hardware was designed. Therefore, this study attempts to investigate the hardware components that are required to design wearable devices that are used in the emerging context of the Internet of Medical Things (IoMT). This means that they can be used, to an extent, for disease monitoring through biosignal capture. In particular, this review study covers the basic components that are required for the front-end of any biomedical wearable, and the limitations that these wearable devices have. Furthermore, there is a discussion of the opportunities that they create, and the direction that the wearable industry is heading in.

Wearable Hardware Design for the Internet of Medical Things (IoMT)

As the life expectancy of individuals increases with recent advancements in medicine and quality of living, it is important to monitor the health of patients and healthy individuals on a daily basis. This is not possible with the current health care system in North America, and thus there is a need for wireless devices that can be used from home. These devices are called biomedical wearables, and they have become popular in the last decade. There are several reasons for that, but the main ones are: expensive health care, longer wait times, and an increase in public awareness about improving quality of life. With this, it is vital for anyone working on wearables to have an overall understanding of how they function, how they were designed, their significance, and what factors were considered when the hardware was designed. Therefore, this study attempts to investigate the hardware components that are required to design wearable devices that are used in the emerging context of the Internet of Medical Things (IoMT). This means that they can be used, to an extent, for disease monitoring through biosignal capture. In particular, this review study covers the basic components that are required for the front-end of any biomedical wearable, and the limitations that these wearable devices have. Furthermore, there is a discussion of the opportunities that they create, and the direction that the wearable industry is heading in.

Drug utilization study in ophthalmology department at a tertiary care hospital

Background: Drug utilisation studies in present clinical practice have played significant role to promote rational drug use in the current health care system. The aim of present study was to analyse the prescribing pattern of drugs for various ocular conditions in Ophthalmology Department of Government Medical College and Hospital, Aurangabad, Maharashtra, India.Methods: Study was prospective, observational open label and descriptive clinical study which included 100 patients in OPD and IPD during November 2018 to February 2019 fulfilling inclusion criteria.Results: Out of the 100 study subjects, 56% were males and 46% were females, with the maximum number of patients falling in the age group 61-80 years. 38.26% patients received antibiotics as most prescribed drug while 69 % patients received analgesics and 47% anti-inflammatory. Among the antibiotics prescribed, fluoroquinolones were the most prescribed antimicrobial class. WHO prescribing indicators as analysed from the data collected were: average number of drugs per prescriptions was 3.79. Percentage of medicines prescribed by branded name- 33.79% and generic were 66.21%. 54% of the total drugs prescribed were from the National List of Essential Medicines 2017.Conclusions: Ocular ailments and conditions are frequently associated with high levels of utilization of drugs for their treatment. Thus, analysis of utilization of these drugs becomes very essential. In the present study, the drugs prescribed at our tertiary care hospital were found rational.